| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 10087 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $8K | $8K | 0.78% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 100 BANK STREET, SUITE 500 BURLINGTON, VT 05401 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $227 | — | $227 | 4.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BL. CR. LF AND HLTH INS. CO. EIN 95-4331852 CONTRACT ADMNSTRTR | Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Insurance brokerage commissions and fees; Other commissions; Contract Administrator; Float revenue Service code 12 | — | $3.4M |
| EMPYREAN BENEFIT SOLUTIONS, INC. EIN 20-3029813 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $289K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACT ADMNSTRTR | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $129K |
| FTBA, INC. EIN 46-4314843 PLAN SPONSOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $81K |
| MOSS ADAMS LLP EIN 91-0189318 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $78K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $43K |
| INGENIO RX, INC. EIN 82-3062245 CONTRACT ADMNSTRTR | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing; Float revenue Service code 12 | — | $41K |
| SONG LAW ATTORNEY | Legal; Direct payment from the plan Service code 29 | 400 KELBY STREET FORT LEE, NJ 07024 | $39K |
| HEALTH ADVOCATE CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan Service code 13 | 3043 WALTON ROAD, SUITE 150 PLYMOUTH MEETING, PA 19462 | $30K |
| PILLSBURY WINTHROP SHAW PITTMAN LP EIN 94-1311126 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $28K |
| ODA CREATIVE PARTNERS, LTD EIN 36-3518696 CONSULTANT | Participant communication; Direct payment from the plan Service code 38 | — | $28K |
| U.S. BANK NATIONAL ASSOCIATION EIN 31-0841368 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $15K |
| ALIGHT SOLUTIONS LLC EIN 36-2235791 CONSULTANT | Direct payment from the plan; Consulting (general) Service code 16 | — | $10K |
| POLSINELLI PC EIN 43-1064260 ATTORNEY | Plan Administrator; Direct payment from the plan Service code 14 | — | $8K |
| OPTUM CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $6K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 2,002 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 82 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 671 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,755 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 4,541 | $2.5M |
| Prescription drug(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 192 | $1.5M |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 4,541 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,541 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.